Standards of medical care in diabetes: focus on updated recommendations in hospitalized patients

Despite efforts to control blood glucose levels in the hospital, an estimated one-fourth of hospitalized patients continue to experience hyperglycemia. Hyperglycemia is linked to poor health outcomes including an increased risk of mortality, need for dialysis, infections, and length of stay. The American Diabetes Association (ADA) publishes clinical practice guidelines annually that provide evidence-based recommendations on all components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Although previous recommendations discuss intensive blood glucose goals for hospitalized patients, updated guidelines suggest a more lenient approach to the management of hyperglycemia. According to the 2009 recommendations, blood glucose levels should be kept as close to 110 mg/dL as possible and generally less than 140 mg/dL. These stringent blood glucose targets were adopted based on the results of the study conducted by Van den Berghe et al. In 2010, the ADA released an updated position statement recommending that blood glucose levels be maintained between 140 and 180 mg/dL in critically ill patients based on the findings of the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial. This article reviews the evidence supporting the updated guidelines for the management of hyperglycemia in the hospital setting. Additional updates to the 2013 recommendations are also discussed. [PUBLICATION ABSTRACT]